RESUMEN
Bone marrow edema (BME) is a self-limiting syndrome that can be caused by many pathological conditions. The most frequently seen symptom of BME is pain. Hyperbaric oxygen therapy (HBOT) is an available treatment. This study aims to present the clinical results of quantitatively evaluating the use of HBOT. We evaluated all BME patients 18 to 65 years old without osteoarthritis, inflammatory rheumatological disease, or malignancy diagnosed through magnetic resonance imaging. All were treated with acetylsalicylic acid (100 mg daily) and bisphosphonates (70 mg alendronate once a week) and were instructed to avoid weight-bearing activities. Some of the patients also received HBOT. We divided the patients into 2 groups: 1 group took HBOT; the other did not. We used the Wilcoxon test to compare groups. HBOT is an effective treatment option for BME. We quantitatively measured faster healing when HBOT was used for BME of the knee. There were no significant side effects.
Asunto(s)
Enfermedades de la Médula Ósea , Oxigenoterapia Hiperbárica , Humanos , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Médula Ósea , Oxigenoterapia Hiperbárica/efectos adversos , Articulación de la Rodilla , Enfermedades de la Médula Ósea/etiología , Edema/etiologíaRESUMEN
BACKGROUND: A study was conducted to assess the effectiveness of holistic nursing intervention upon the knowledge regarding care during myelosupression among patients with cancer at a selected hospital in Chennai, India. METHODS: A quantitative research approach of quasi experimental non-equivalent with control group before -after design (non randomized) was used. The investigator included 204 participants by using purposive sampling technique which included 102 each in study and comparison group. Pre-test was done before the intervention of holistic nursing to both comparison and study group participants. Holistic nursing intervention was implemented for study group whereas comparison group received routine care. Post test was done by using the structured questionnaire after 1month. The responses from the participants were coded and statistically analyzed by using descriptive and inferential statistics. RESULTS: The knowledge scores obtained by study group was significantly higher (13.32+2.94) when compared to comparison group (8.12+2.04). There was a statistically significant difference between study and comparison group participants, at p< 0.001. With regard to the dimensions of knowledge related to disease condition and signs and symptoms were higher in the study group when compared to the comparison group. The difference was statistically significant at p.
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Enfermedades de la Médula Ósea/enfermería , Enfermedades de la Médula Ósea/psicología , Conocimientos, Actitudes y Práctica en Salud , Enfermería Holística/métodos , Neoplasias/complicaciones , Calidad de Vida , Adulto , Enfermedades de la Médula Ósea/etiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Encuestas y CuestionariosRESUMEN
Bone Marrow Oedema Syndrome during childhood is a rare benign transient condition without clear pathophysiology. It usually resolves after conservative treatment, but resolution may exceed up to 8 months. A 12-year-old child with bone marrow oedema of the left foot which was diagnosed by magnetic resonance imaging (MRI) is reported. She presented with a six week subacute pain and mild swelling on the dorsal surface of the foot. Routine plain radiographs, blood tests, biochemical and serological tests were normal with the exception of serum Vitamin D levels that were reduced. The management of the child included partial weight-bearing, administration of anti-inflammatory drugs and supplementation of Vitamin D due to insufficient Vitamin D intake. After six months the child did not have any clinical symptoms and MRI showed complete resolution of the oedema. This is the first report of a juvenile bone marrow oedema correlated with hypovitaminosis D that was successfully treated with Vitamin D administration.
Asunto(s)
Enfermedades de la Médula Ósea/etiología , Edema/etiología , Enfermedades del Pie/etiología , Deficiencia de Vitamina D/complicaciones , Vitamina D/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Biomarcadores/sangre , Enfermedades de la Médula Ósea/diagnóstico por imagen , Enfermedades de la Médula Ósea/tratamiento farmacológico , Niño , Edema/diagnóstico por imagen , Edema/tratamiento farmacológico , Femenino , Enfermedades del Pie/diagnóstico por imagen , Humanos , Deficiencia de Vitamina D/tratamiento farmacológicoRESUMEN
BACKGROUND: The aim of this study was to evaluate effects of Shen-Cao granules for the prevention of thrombocytopenia caused by anticancer chemotherapy. METHODS: In this prospective study, a total of 200 patients with various malignant tumors were enrolled and evenly divided into a Shen-Cao granule treatment (nâ=â100) and a control group (nâ=â100). After 2 cycles chemotherapy with any combination of platinum-based drugs (cisplatin, carboplatin, and nedaplatin), the blood platelet (PLT) counts, levels of the PLT production regulator thrombopoietin (TPO), PLT aggregation rates, and the PLT activation marker CD62P expressions were monitored for 2 weeks. RESULTS: During 2 weeks of post-chemotherapy, the mean values of the minimum PLT count were 49.65â±â7.35 × 10/L in the treatment group and 31.56â±â9.32 × 10/L in the control group. The PLT count in the treatment group reached the lowest value 1.8 days later and recovered to a concentration ≥100â×â10/L 3 days earlier than in the control group. The concentrations of the TPO were 71.43â±â1.74 and 87.24â±â0.92âng/mL in the treatment group and 65.75â±â1.39 and 67.75â±â0.67âng/mL in the control group at 7 and 14 days post-chemotherapy, respectively. The maximum PLT aggregation rate declined after chemotherapy in the treatment group from 58.14â±â11.46% to 52.89â±â10.52%, while it increased in the control group from 56.94â±â10.55% to 61.75â±â12.26%. Coordinately, the expression of CD62P in the treatment group decreased from 6.17â±â0.59% to 4.89â±â0.72%, while it increased from 6.09â±â0.75% to 7.75â±â0.67% in the control group. CONCLUSION: Our study demonstrated that Shen-Cao granule treatment alleviated thrombocytopenia after chemotherapy, and reduced tumor-induced PLT activation and aggregation.
Asunto(s)
Antineoplásicos/efectos adversos , Medicina Tradicional China , Neoplasias/tratamiento farmacológico , Compuestos de Platino/efectos adversos , Adulto , Anciano , Antineoplásicos/uso terapéutico , Plaquetas/efectos de los fármacos , Plaquetas/metabolismo , Médula Ósea/efectos de los fármacos , Médula Ósea/metabolismo , Enfermedades de la Médula Ósea/tratamiento farmacológico , Enfermedades de la Médula Ósea/etiología , Carboplatino/efectos adversos , Carboplatino/uso terapéutico , Cisplatino/efectos adversos , Cisplatino/uso terapéutico , Quimioterapia Combinada/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/sangre , Compuestos Organoplatinos/efectos adversos , Compuestos Organoplatinos/uso terapéutico , Activación Plaquetaria/efectos de los fármacos , Agregación Plaquetaria/efectos de los fármacos , Compuestos de Platino/uso terapéutico , Trombocitopenia/tratamiento farmacológico , Trombocitopenia/etiología , Adulto JovenRESUMEN
PURPOSE/OBJECTIVE(S): To quantify ensuing bone marrow (BM) suppression during postoperative chemotherapy resulting from preoperative chemoradiation (CRT) therapy for rectal cancer. METHODS AND MATERIALS: We retrospectively evaluated 35 patients treated with preoperative CRT followed by postoperative 5-Fluorouracil and oxaliplatin (OxF) chemotherapy for locally advanced rectal cancer. The pelvic bone marrow (PBM) was divided into ilium (IBM), lower pelvis (LPBM), and lumbosacrum (LSBM). Dose volume histograms (DVH) measured the mean doses and percentage of BM volume receiving between 5-40 Gy (i.e.: PBM-V5, LPBM-V5). The Wilcoxon signed rank tests evaluated the differences in absolute hematologic nadirs during neoadjuvant vs. adjuvant treatment. Logistic regressions evaluated the association between dosimetric parameters and ≥ grade 3 hematologic toxicity (HT3) and hematologic event (HE) defined as ≥ grade 2 HT and a dose reduction in OxF. Receiver Operator Characteristic (ROC) curves were constructed to determine optimal threshold values leading to HT3. RESULTS: During OxF chemotherapy, 40.0% (n=14) and 48% (n=17) of rectal cancer patients experienced HT3 and HE, respectively. On multivariable logistic regression, increasing pelvic mean dose (PMD) and lower pelvis mean dose (LPMD) along with increasing PBM-V (25-40), LPBM-V25, and LPBM-V40 were significantly associated with HT3 and/or HE during postoperative chemotherapy. Exceeding ≥36.6 Gy to the PMD and ≥32.6 Gy to the LPMD strongly correlated with causing HT3 during postoperative chemotherapy. CONCLUSIONS: Neoadjuvant RT for rectal cancer has lasting effects on the pelvic BM, which are demonstrable during adjuvant OxF. Sparing of the BM during preoperative CRT can aid in reducing significant hematologic adverse events and aid in tolerance of postoperative chemotherapy.
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Antineoplásicos/efectos adversos , Enfermedades de la Médula Ósea/etiología , Médula Ósea/efectos de los fármacos , Médula Ósea/efectos de la radiación , Quimioradioterapia/efectos adversos , Neoplasias del Recto/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Capecitabina/administración & dosificación , Capecitabina/efectos adversos , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Humanos , Ilion/efectos de la radiación , Leucovorina/administración & dosificación , Leucovorina/efectos adversos , Leucopenia/etiología , Modelos Logísticos , Vértebras Lumbares/efectos de la radiación , Masculino , Persona de Mediana Edad , Neutropenia/etiología , Compuestos Organoplatinos/administración & dosificación , Compuestos Organoplatinos/efectos adversos , Oxaliplatino , Huesos Pélvicos/efectos de la radiación , Cuidados Preoperatorios , Curva ROC , Neoplasias del Recto/patología , Estudios Retrospectivos , Sacro/efectos de la radiación , Estadísticas no Paramétricas , Trombocitopenia/etiologíaRESUMEN
STUDY DESIGN: Prospective observational study. OBJECTIVE: To assess (1) the evolution of vertebral bone marrow edema (VBME) in patients with A1 vertebral compression fractures (VCFs) conservatively treated and (2) the relationship between VBME and clinical symptoms, evaluated as Visual Analogue Scale (VAS) back pain and Oswestry Disability Index (ODI). SUMMARY OF BACKGROUND DATA: VBME is a marker of acute-subacute vertebral fractures. Little is known about the evolution of VBME in conservatively managed VCFs, as well as its clinical meaning. METHODS: 82 thoracic or lumbar VCFs (21 post-traumatic; 61 osteoporotic VCFs), type A1 according to the AOSpine thoracolumbar spine injury classification system, in 80 patients were treated with C35 hyperextension brace for 3 months, bed rest for the first 25 days. Patients with osteoporotic fractures also received antiresorptive therapy and vitamin D supplementation. At 0 (T0), 30 (T1), 60 (T2), and 90 (T3) days, patients underwent magnetic resonance imaging evaluation and clinical evaluation, using VAS for pain and ODI.The paired t test was used to compare changes within groups at each follow-up versus baseline. The unpaired t test after ANOVA (analysis of variance) was used to compare the 2 groups at each follow-up.The association between VBME area, VAS score, and ODI score was analyzed by the Pearson correlation test. The tests were 2-tailed with a confidence level of 5%. RESULTS: A significant VBME mean area, VAS, and ODI scores reduction was recorded at 60 and 90-days follow-ups versus baseline. A positive correlation between VBME reduction and clinical symptoms improvement (VAS and ODI scores improvement) was found in both traumatic and osteoporotic VCFs. CONCLUSION: In benign A1 VCFs conservatively managed, VBME slowly decreases in the first 3 months of magnetic resonance imaging follow-up. This VBME reduction is related to clinical symptoms improvement. LEVEL OF EVIDENCE: 4.
Asunto(s)
Enfermedades de la Médula Ósea/epidemiología , Enfermedades de la Médula Ósea/etiología , Edema/epidemiología , Edema/etiología , Fracturas por Compresión/complicaciones , Fracturas de la Columna Vertebral/complicaciones , Anciano , Anciano de 80 o más Años , Médula Ósea/diagnóstico por imagen , Médula Ósea/patología , Femenino , Fracturas por Compresión/terapia , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Fracturas de la Columna Vertebral/terapiaRESUMEN
OBJECTIVE: We sought to develop a comprehensive scoring system for evaluation of pre-clinical models of osteoarthritis (OA) progression, and use this to evaluate two different classes of drugs for management of OA. METHODS: Post-traumatic OA (PTOA) was surgically induced in skeletally mature rats. Rats were randomly divided in three groups receiving either glucosamine (high dose of 192 mg/kg) or celecoxib (clinical dose) or no treatment. Disease progression was monitored utilizing micro-magnetic resonance imaging (MRI), micro-computed tomography (CT) and histology. Pertinent features such as osteophytes, subchondral sclerosis, joint effusion, bone marrow lesion (BML), cysts, loose bodies and cartilage abnormalities were included in designing a sensitive multi-modality based scoring system, termed the rat arthritis knee scoring system (RAKSS). RESULTS: Overall, an inter-observer correlation coefficient (ICC) of greater than 0.750 was achieved for each scored feature. None of the treatments prevented cartilage loss, synovitis, joint effusion, or sclerosis. However, celecoxib significantly reduced osteophyte development compared to placebo. Although signs of inflammation such as synovitis and joint effusion were readily identified at 4 weeks post-operation, we did not detect any BML. CONCLUSION: We report the development of a sensitive and reliable multi-modality scoring system, the RAKSS, for evaluation of OA severity in pre-clinical animal models. Using this scoring system, we found that celecoxib prevented enlargement of osteophytes in this animal model of PTOA, and thus it may be useful in preventing OA progression. However, it did not show any chondroprotective effect using the recommended dose. In contrast, high dose glucosamine had no measurable effects.
Asunto(s)
Inhibidores de la Ciclooxigenasa 2/uso terapéutico , Modelos Animales de Enfermedad , Osteoartritis de la Rodilla/diagnóstico , Osteoartritis de la Rodilla/tratamiento farmacológico , Pirazoles/uso terapéutico , Sulfonamidas/uso terapéutico , Animales , Ligamento Cruzado Anterior/cirugía , Quistes Óseos/diagnóstico , Quistes Óseos/tratamiento farmacológico , Quistes Óseos/etiología , Enfermedades de la Médula Ósea/diagnóstico , Enfermedades de la Médula Ósea/tratamiento farmacológico , Enfermedades de la Médula Ósea/etiología , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/patología , Celecoxib , Progresión de la Enfermedad , Glucosamina/uso terapéutico , Traumatismos de la Rodilla , Imagen por Resonancia Magnética , Osteoartritis de la Rodilla/etiología , Osteofito/diagnóstico , Osteofito/tratamiento farmacológico , Osteofito/etiología , Ratas , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Sinovitis/diagnóstico , Sinovitis/tratamiento farmacológico , Sinovitis/etiología , Microtomografía por Rayos XRESUMEN
UNLABELLED: Based on this double-blind, placebo-controlled study, ibandronate has no beneficial effect on clinical and radiological outcome in patients with spontaneous osteonecrosis of the knee over and above anti-inflammatory medication. INTRODUCTION: Observational studies suggest beneficial effects of bisphosphonates in spontaneous osteonecrosis (ON) of the knee. We investigated whether ibandronate would improve clinical and radiological outcome in newly diagnosed ON. METHODS: In this randomized, double-blind, placebo-controlled trial, 30 patients (mean age, 57.3 ± 10.7 years) with ON of the knee were assigned to receive either ibandronate (cumulative dose, 13.5 mg) or placebo intravenously (divided into five doses 12 weeks). All subjects received additional treatment with oral diclofenac (70 mg) and supplementation with calcium carbonate (500 mg) and vitamin D (400 IU) to be taken daily for 12 weeks. Patients were followed for 48 weeks. The primary outcome was the change in pain score after 12 weeks. Secondary endpoints included changes in pain score, mobility, and radiological outcome (MRI) after 48 weeks. RESULTS: At baseline, both treatment groups (IBN, n = 14; placebo, n = 16) were comparable in relation to pain score and radiological grading (bone marrow edema, ON). After 12 weeks, mean pain score was reduced in both ibandronate- (mean change, -2.98; 95% CI, -4.34 to -1.62) and placebo- (-3.59; 95% CI, -5.07 to -2.12) treated subjects (between-group comparison adjusted for age, sex, and osteonecrosis type, p = ns). Except for significant decrease in bone resorption marker (CTX) in ibandronate-treated subjects (p < 0.01), adjusted mean changes in all functional and radiological outcome measures were comparable between treatment groups after 24 and 48 weeks. CONCLUSIONS: In patients with spontaneous osteonecrosis of the knee, bisphosphonate treatment (i.e., IV ibandronate) has no beneficial effect over and above anti-inflammatory medication.
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Conservadores de la Densidad Ósea/uso terapéutico , Difosfonatos/uso terapéutico , Articulación de la Rodilla , Osteonecrosis/tratamiento farmacológico , Adulto , Anciano , Enfermedades de la Médula Ósea/diagnóstico , Enfermedades de la Médula Ósea/tratamiento farmacológico , Enfermedades de la Médula Ósea/etiología , Método Doble Ciego , Edema/diagnóstico , Edema/tratamiento farmacológico , Edema/etiología , Femenino , Estudios de Seguimiento , Humanos , Ácido Ibandrónico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Osteonecrosis/complicaciones , Osteonecrosis/diagnóstico , Dimensión del Dolor/métodos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto JovenRESUMEN
The detonation of a nuclear weapon or a nuclear accident represent possible events with significant exposure to mixed neutron/γ-radiation fields. Although radiation countermeasures generally have been studied in subjects exposed to pure photons (γ or X rays), the mechanisms of injury of these low linear energy transfer (LET) radiations are different from those of high-LET radiation such as neutrons, and these differences may affect countermeasure efficacy. We compared 30-day survival in mice after varying doses of pure γ and mixed neutron/γ (mixed field) radiation (MF, Dn/Dt = 0.65), and also examined peripheral blood cells, bone marrow cell reconstitution, and cytokine expression. Mixed-field-irradiated mice displayed prolonged defects in T-cell populations compared to mice irradiated with pure γ photons. In mouse survival assays, the growth factor granulocyte colony-stimulating factor (G-CSF) was effective as a (post-irradiation) mitigator against both γ-photons and mixed-field radiation, while the thrombopoietin (TPO) mimetic ALXN4100TPO was effective only against γ irradiation. The results indicate that radiation countermeasures should be tested against radiation qualities appropriate for specific scenarios before inclusion in response plans.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Enfermedades de la Médula Ósea/prevención & control , Rayos gamma/efectos adversos , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Neutrones/efectos adversos , Traumatismos Experimentales por Radiación/prevención & control , Protectores contra Radiación/uso terapéutico , Trombopoyetina/uso terapéutico , Animales , Anticuerpos Monoclonales Humanizados , Médula Ósea/efectos de los fármacos , Médula Ósea/patología , Médula Ósea/efectos de la radiación , Enfermedades de la Médula Ósea/sangre , Enfermedades de la Médula Ósea/etiología , Enfermedades de la Médula Ósea/inmunología , Citocinas/sangre , Evaluación Preclínica de Medicamentos , Filgrastim , Hematopoyesis/efectos de los fármacos , Hematopoyesis/efectos de la radiación , Células Madre Hematopoyéticas/efectos de los fármacos , Células Madre Hematopoyéticas/patología , Células Madre Hematopoyéticas/efectos de la radiación , Recuento de Linfocitos , Ratones , Traumatismos Experimentales por Radiación/sangre , Traumatismos Experimentales por Radiación/etiología , Traumatismos Experimentales por Radiación/inmunología , Proteínas Recombinantes/uso terapéutico , Bazo/efectos de los fármacos , Bazo/patología , Bazo/efectos de la radiación , Linfocitos T/efectos de la radiaciónAsunto(s)
Bencenosulfonatos/uso terapéutico , Crisis Blástica/tratamiento farmacológico , Enfermedades de la Médula Ósea/tratamiento farmacológico , Leucemia Mieloide Aguda/tratamiento farmacológico , Mutación/genética , Piridinas/uso terapéutico , Secuencias Repetidas en Tándem/genética , Tirosina Quinasa 3 Similar a fms/genética , Anciano , Antineoplásicos/uso terapéutico , Enfermedades de la Médula Ósea/etiología , Humanos , Secuencias Invertidas Repetidas/genética , Leucemia Mieloide Aguda/complicaciones , Leucemia Mieloide Aguda/genética , Masculino , Persona de Mediana Edad , Niacinamida/análogos & derivados , Compuestos de Fenilurea , SorafenibRESUMEN
OBJECTIVE: There is evidence that omega-3 polyunsaturated fatty acids alleviate the progression of osteoarthritis (OA). However, little work has been done to investigate the effect of fatty acids on bone marrow lesions and knee cartilage in healthy subjects. We examined this in a cohort of healthy middle-aged subjects without clinical knee OA. METHODS: Two hundred and ninety-three healthy adults without knee pain or injury were recruited from an existing community-based cohort. Intakes of fatty acids and food sources of these were estimated from a food frequency questionnaire at baseline. Tibial cartilage volume, tibial plateau bone area, tibiofemoral cartilage defects and bone marrow lesions were assessed approximately 10 years later using magnetic resonance imaging. RESULTS: In multivariate analyses, higher intakes of monounsaturated fatty acids (OR=2.14, 95% CI 1.04-4.39, P=0.04), total (OR=1.77, 95% CI 1.13-2.77, P=0.01) and n-6 polyunsaturated fatty acids (OR=1.69, 95% CI 1.10-2.61, P=0.02) were associated with an increased risk of bone marrow lesions. Intake of fatty acids was not significantly associated with cartilage volume or cartilage defects. CONCLUSION: These findings support the dietary recommendation towards a shift to foods rich in n-3 polyunsaturated fatty acids in order to maintain an optimal balance between dietary n-3 and n-6 polyunsaturated fatty acids, which is also important in the prevention of atherosclerosis. Although our findings will need to be confirmed in longitudinal studies, they suggest the potential of fatty acids to adversely effect the knee joint.
Asunto(s)
Enfermedades de la Médula Ósea/etiología , Cartílago Articular/efectos de los fármacos , Ácidos Grasos/administración & dosificación , Articulación de la Rodilla/efectos de los fármacos , Adulto , Anciano , Antropometría/métodos , Enfermedades de la Médula Ósea/patología , Enfermedades de la Médula Ósea/prevención & control , Cartílago Articular/patología , Estudios de Cohortes , Dieta/efectos adversos , Ácidos Grasos/efectos adversos , Ácidos Grasos Omega-3/administración & dosificación , Ácidos Grasos Omega-6/administración & dosificación , Ácidos Grasos Omega-6/efectos adversos , Femenino , Humanos , Articulación de la Rodilla/patología , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Tibia/patologíaRESUMEN
The protective effects of Mentha piperita (Linn) extract against radiation induced hematopoietic damage in bone marrow of Swiss albino mice have been studied. Mice were given either double distilled water or leaf extract of M. piperita orally (1 g/kg b.wt./day) once a day for three consecutive days, and after 30 min of treatments on the third day were exposed to 8 Gy gamma radiation. Mice were autopsied at 12, 24, 48 hrs and 5, 10 and 20 days post-irradiation to evaluate the percentage of bone marrow cells, frequency of micronuclei and erythropoietin level in serum. An exposure to gamma radiation resulted in a significant decline in the number of bone marrow cells such as leucoblasts, myelocytes, metamyelocytes, band/stab forms, polymorphs, pronormoblasts and normoblasts, lymphocytes, and megakaryocytes. Pretreatment with leaf extract of M. piperita followed by radiation exposure resulted in significant increases in the numbers of leucoblasts, myelocytes, metamyelocytes, band/stab forms, polymorphs, pronormoblasts and normoblasts, lymphocytes, and megakaryocytes in bone marrow as compared to the control group. Pretreatment with leaf extract of M. piperita followed by radiation exposure also resulted in significant decreases in micronucleus frequencies in bone marrow of Swiss albino mice. A significant increase in erythropoietin level was observed at all the studied intervals in leaf extract of M. piperita pretreated irradiated animals as compared to control animals (radiation alone). The results of the present investigation suggest the protective effects of leaf extract of M. piperita against radiation induced hematopoietic damage in bone marrow may be attributed to the maintenance of EPO level in Swiss albino mice.
Asunto(s)
Enfermedades de la Médula Ósea/prevención & control , Médula Ósea/efectos de los fármacos , Médula Ósea/efectos de la radiación , Mentha piperita/química , Fitoterapia/métodos , Extractos Vegetales/administración & dosificación , Traumatismos por Radiación/prevención & control , Animales , Médula Ósea/patología , Enfermedades de la Médula Ósea/etiología , Enfermedades de la Médula Ósea/patología , Relación Dosis-Respuesta a Droga , Relación Dosis-Respuesta en la Radiación , Hematopoyesis/efectos de los fármacos , Hematopoyesis/efectos de la radiación , Masculino , Ratones , Traumatismos por Radiación/etiología , Traumatismos por Radiación/patología , Protectores contra Radiación/administración & dosificaciónRESUMEN
Bone marrow and intestinal damage limits the efficacy of radiotherapy for cancer and can result in death if the whole body is exposed to too high a dose, as might be the case in a nuclear accident or terrorist incident. Identification of an effective nontoxic biological radioprotector is therefore a matter of some urgency. In this study, we show that an orally administered hot-water extract from a Chinese herbal medicine, Cordyceps sinensis (CS), protects mice from bone marrow and intestinal injuries after total-body irradiation (TBI). CS increased the median time to death from 13 to 20 days after 8 Gy TBI and from 9 to 18 days after 10 Gy TBI. Although CS-treated mice receiving 10 Gy TBI survived intestinal injury, most died from bone marrow failure, as shown by severe marrow hypoplasia in mice dying between 18 and 24 days. At lower TBI doses of 5.5 and 6.5 Gy, CS protected against bone marrow death, an effect that was confirmed by the finding that white blood cell counts recovered more rapidly. In vitro, CS reduced the levels of free radical species (ROS) within cells, and this is one likely mechanism for the radioprotective effects of CS, although probably not the only one.
Asunto(s)
Enfermedades de la Médula Ósea/prevención & control , Cordyceps/química , Medicamentos Herbarios Chinos/administración & dosificación , Enfermedades Intestinales/prevención & control , Traumatismos por Radiación/patología , Traumatismos por Radiación/prevención & control , Tolerancia a Radiación/efectos de los fármacos , Animales , Enfermedades de la Médula Ósea/etiología , Enfermedades de la Médula Ósea/patología , Enfermedades Intestinales/etiología , Enfermedades Intestinales/patología , Ratones , Ratones Endogámicos C57BL , Protección Radiológica/métodos , Tasa de SupervivenciaRESUMEN
BACKGROUND: There is a striking need for additional therapies of bone marrow oedema (BME) and aseptic osteonecrosis (AON) in paediatric oncology patients. Hyperbaric oxygenation (HBO) therapy used in the treatment of osteoradionecrosis is demonstrated effectiveness. Aim of this retrospective analysis was to investigate whether HBO-therapy might lead to subjective as well as objective effects in the treatment of BME and/or AON in paediatric oncology patients with acute lymphoblastic leukaemia (ALL) or Non-Hodgkin lymphoma (NHL). PATIENTS AND METHODS: Between 11/1988 and 01/2001 27/291 (9.3 %) patients with ALL or NHL were diagnosed with a BME and/or AON in the Clinic for Paediatric Oncology, Haematology, and Immunology at University of Dusseldorf. 19/27 patients were submitted to HBO-therapy. Patients received average 45 HBO-treatments per patient (min. 13, max. 80 treatments). The affected regions were re-evaluated with MRI for radiological extent of lesions every 3 months. Pain in its intensity and localisation was serially recorded during HBO-therapy as key symptom in 11 of 19 patients. RESULTS: 27 patients (15 females, 12 males; mean age at diagnosis of malignancy 8.2 +/- 4.7 (SD) years, range 7 months to 16 years) presented with 138 lesions. 133/138 lesions were localised in the lower extremities. At diagnosis of BME and/or AON, 78/133 lesions were shown in females and 55/133 lesions in male. Girls < 10 years predominantly presented BME (33 BME vs. 6 AON), girls aged > 10 years predominantly offered AON (28 AON vs. 11 BME). BME was more often exhibited in boys < 10 years (34 BME vs. 10 AON) and rarely in boys > 10 years (4 BME vs. 6 AON). 11 patients treated with HBO-therapy were serially evaluated for pain intensity throughout their HBO-therapy courses by visual analogue scale (VAS) assessment. During the first 15 treatment courses the HBO-therapy a clear-cut reduction of pain was observed. The mean pain score before the first HBO-treatment unit was 2.4 +/- 2.7 (X +/- SD), decreased before the fifth to 1.6 +/- 1.7 and prior to the 35 (th) and 40 (th) HBO treatment to 0. Girls < 10 years treated with HBO showed an increase of BME (31 --> 46) and declining AON numbers (6 --> 2). Girls > 10 years with and without HBO-therapy showed decrease of BME lesions (7 --> 4 vs. 4 --> 0), whereas AON increased in the HBO-treated group (28 --> 29) as well as the non-treated group (0 --> 4). Males < 10 years showed an increase in BME lesion numbers despite HBO intervention (24 --> 26). The AON lesion numbers dropped in parallel (6 --> 3). Male patients not treated with HBO showed constant numbers of BME (11-->11) and a decreased numbers of AON (4 --> 2). All differences are statistically not significant. CONCLUSIONS: Children and adolescents diagnosed with ALL or NHL have a risk for accruement of BME and/or AON irrespective of the age, with an almost exclusive involvement of the lower extremities. Lesions of pedal bones and ankle joints predominantly affect children < 10 years. Lesions of knee and hip joints predominantly affect children > 10 years. In children < 10 years of age we demonstrate declining AON numbers and conversion of AON to BME thereby implicating possible beneficial effect of HBO in such patients. HBO failed to show beneficial effect on BME whether by preventing new lesions or by improving existent lesions in children > 10 years.
Asunto(s)
Enfermedades de la Médula Ósea/terapia , Edema/terapia , Oxigenoterapia Hiperbárica , Linfoma no Hodgkin/complicaciones , Osteonecrosis/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Adolescente , Factores de Edad , Enfermedades de la Médula Ósea/diagnóstico , Enfermedades de la Médula Ósea/etiología , Enfermedades de la Médula Ósea/cirugía , Niño , Preescolar , Interpretación Estadística de Datos , Edema/diagnóstico , Edema/etiología , Edema/cirugía , Femenino , Estudios de Seguimiento , Humanos , Linfoma no Hodgkin/terapia , Masculino , Osteonecrosis/diagnóstico , Osteonecrosis/etiología , Osteonecrosis/cirugía , Dimensión del Dolor , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Resultado del TratamientoRESUMEN
A sufficiently high dose of thrombopoietin to overcome initial c-mpl-mediated clearance stimulates hematopoietic reconstitution following myelosuppressive treatment. We studied the efficacy of thrombopoietin on survival after supralethal total body irradiation (9 Gy) of C57BL6/J mice and the occurrence of infectious and thrombotic complications in comparison with a bone marrow graft or prophylactic antibiotic treatment. Administration of 0.3 microg thrombopoietin, 2 hours after irradiation, protected 62% of the mice as opposed to no survival in placebo controls. A graft with a supraoptimal number of syngeneic bone marrow cells (10(6) cells) fully prevented mortality, whereas antibiotic treatment was ineffective. Blood cell recovery was observed in the thrombopoietin-treated mice but not in the placebo or antibiotic-treated group. Bone marrow and spleen cellularity as well as colony-forming unit granulocyte-macrophage and burst-forming unit erythroid were considerably increased in thrombopoietin-treated mice relative to controls. Histologic examination at day 11 revealed numerous petechiae and vascular obstructions within the brain microvasculature of placebo-treated mice, which was correlated with hypercoagulation and hypofibrinolysis. Thrombopoietin treatment prevented coagulation/fibrinolysis disorder and vascular thrombosis. High fibrinogen levels were related to bacterial infections in 67% of placebo-treated mice and predicted mortality, whereas the majority of the thrombopoietin-treated mice did not show high fibrinogen levels and endotoxin was not detectable in plasma. We conclude that thrombopoietin administration prevents mortality in mice subjected to 9-Gy total body irradiation both by interfering in the cascade leading to thrombotic complications and by amelioration of neutrophil and platelet recovery and thus protects against infections and hemorrhages.
Asunto(s)
Infecciones Bacterianas/prevención & control , Traumatismos Experimentales por Radiación/tratamiento farmacológico , Trombopoyetina/uso terapéutico , Trombosis/prevención & control , Animales , Infecciones Bacterianas/etiología , Biomarcadores , Trastornos de la Coagulación Sanguínea/etiología , Médula Ósea/efectos de los fármacos , Enfermedades de la Médula Ósea/complicaciones , Enfermedades de la Médula Ósea/etiología , Susceptibilidad a Enfermedades , Evaluación Preclínica de Medicamentos , Endotoxemia/etiología , Endotoxemia/prevención & control , Fibrinógeno/análisis , Fibrinógeno/biosíntesis , Fibrinógeno/genética , Fibrinólisis/efectos de los fármacos , Hemorragia/etiología , Hemorragia/prevención & control , Síndromes de Inmunodeficiencia/etiología , Recuento de Leucocitos , Masculino , Ratones , Ratones Endogámicos C57BL , Neutrófilos , Activación Plaquetaria/efectos de los fármacos , Recuento de Plaquetas , ARN Mensajero/biosíntesis , Traumatismos Experimentales por Radiación/sangre , Traumatismos Experimentales por Radiación/complicaciones , Traumatismos Experimentales por Radiación/inmunología , Proteínas Recombinantes/farmacología , Proteínas Recombinantes/uso terapéutico , Trombopoyetina/farmacología , Trombosis/etiología , Irradiación Corporal Total/efectos adversosRESUMEN
Myelopoietins (MPOs) constitute a family of engineered, chimeric molecules that bind and activate the IL-3 and G-CSF receptors on hematopoietic cells. This study investigated the in vivo hematopoietic response of rhesus monkeys administered MPO after radiation-induced myelosuppression. Animals were total body irradiated (TBI) in 2 series, with biologically equivalent doses consisting of either a 700 cGy dose of Cobalt-60 ((60)Co) gamma-radiation or 600 cGy, 250 kVp x-irradiation. First series: On day 1 after 700 cGy irradiation, cohorts of animals were subcutaneously (SC) administered MPO at 200 microg/kg/d (n = 4), or 50 microg/kg/d (n = 2), twice daily, or human serum albumin (HSA) (n = 10). Second series: The 600 cGy x-irradiated cohorts of animals were administered either MPO at 200 microg/kg/d, in a daily schedule (n = 4) or 0.1% autologous serum (AS), daily, SC (n = 11) for 23 days. MPO regardless of administration schedule (twice a day or every day) significantly reduced the mean durations of neutropenia (absolute neutrophil count [ANC] < 500/microL) and thrombocytopenia (platelet < 20,000/microL) versus respective control-treated cohorts. Mean neutrophil and platelet nadirs were significantly improved and time to recovery for neutrophils (ANC to < 500/microL) and platelets (PLT < 20,000/microL) were significantly enhanced in the MPO-treated cohorts versus controls. Red cell recovery was further improved relative to control-treated cohorts that received whole blood transfusions. Significant increases in bone marrow-derived clonogenic activity was observed by day 14 after TBI in MPO-treated cohorts versus respective time-matched controls. Thus, MPO, administered daily was as effective as a twice daily schedule for multilineage recovery in nonhuman primates after high-dose, radiation-induced myelosuppression.
Asunto(s)
Enfermedades de la Médula Ósea/etiología , Hematopoyesis/efectos de los fármacos , Factores de Crecimiento de Célula Hematopoyética/uso terapéutico , Traumatismos Experimentales por Radiación/tratamiento farmacológico , Receptores de Factor Estimulante de Colonias de Granulocito/agonistas , Receptores de Interleucina-3/agonistas , Proteínas Recombinantes de Fusión , Irradiación Corporal Total/efectos adversos , Animales , Recuento de Células Sanguíneas/efectos de los fármacos , Transfusión Sanguínea , Linaje de la Célula , Ensayo de Unidades Formadoras de Colonias , Relación Dosis-Respuesta en la Radiación , Diseño de Fármacos , Evaluación Preclínica de Medicamentos , Factor Estimulante de Colonias de Granulocitos , Factores de Crecimiento de Célula Hematopoyética/química , Factores de Crecimiento de Célula Hematopoyética/farmacología , Interleucina-3 , Macaca mulatta , Masculino , Neutropenia/tratamiento farmacológico , Neutropenia/etiología , Ingeniería de Proteínas , Proteínas Recombinantes , Trombocitopenia/tratamiento farmacológico , Trombocitopenia/etiologíaRESUMEN
BACKGROUND AND OBJECTIVE: Systemic mastocytosis is a rather rare disorder involving the skin and several other organs. The aim of this study was to analyse the extent of extracutaneous manifestations in 14 adult patients who presented with prominent cutaneous involvement within the last 5 years. RESULTS: The cutaneous lesions were clinically diagnosed as telangiectasia macularis eruptiva perstans in 2 patients, urticaria pigmentosa of varying extent in 11 and diffuse erythrodermic mastocytosis in 1 patient. All patients had extracutaneous manifestations with involvement of one additional organ system in 6/14 cases, two in 5/14 and three in 3/14. Ten out of 14 patients suffered from generalized pruritus, and 11/14 reported mild wheal formation, while 3/14 with multi-organ involvement mentioned recurrent flushing episodes. The gastro-intestinal tract was involved in 8/14 cases with an increase in gastric and colon mucosal mast cells in 5/8 cases and gastroduodenitis in 2. Bone marrow involvement was seen in 7/13 patients, hepatosplenomegaly in 2, anaemia in 2 and thrombocytopenia in 3. The disease had a duration of 0.5-32 years, clinical symptoms remaining basically unchanged. Malignant transformation was not seen; only 1 patient developed myelodysplastic syndrome within 2 years after the first cutaneous lesions. CONCLUSIONS: Our study shows that extracutaneous involvement should be carefully considered in adult patients with cutaneous mastocytosis. Systemic multi-organ mast cell disease in adults is a long-lasting disorder with recurrent episodes of varying clinical symptomatology. However, the disease shows rather slow progression, and malignant transformation is rare. Satisfactory management is achieved by symptomatic oral drug intake.
Asunto(s)
Mastocitosis/patología , Piel/patología , Adulto , Anciano , Anemia/etiología , Antiasmáticos/uso terapéutico , Biomarcadores/sangre , Biomarcadores/orina , Enfermedades de la Médula Ósea/etiología , Cromolin Sódico/uso terapéutico , Femenino , Enfermedades Gastrointestinales/etiología , Hepatomegalia/etiología , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Antagonistas de los Receptores H2 de la Histamina/uso terapéutico , Humanos , Masculino , Mastocitos/patología , Mastocitosis/complicaciones , Mastocitosis/terapia , Persona de Mediana Edad , Terapia PUVA , Pronóstico , Piel/efectos de los fármacos , Esplenomegalia/etiología , Trombocitopenia/etiologíaRESUMEN
OBJECTIVE: To review the magnetic resonance imaging (MRI) appearance of bone marrow edema (BME) and to discuss the applications of this imaging modality in the diagnosis of associated disorders. A case of BME in the foot is also provided to acquaint the reader with how MRI may assist in establishing a differential diagnosis in patients with normal radiographs and clinical findings that suggest osseous injury. CLINICAL FEATURES: A 42-yr-old woman suffered from persistent pain along the dorsum of her foot that worsened with jogging. There was foot pronation and palpable pain and swelling at the third tarsometatarsal joint. An MRI was performed, but it was initially misinterpreted. A second review of the MRI examination established the presence of stress-induced BME adjacent to the articular margins of the third tarsometatarsal joint. INTERVENTION AND OUTCOME: Medical treatment consisted of a cortisone injection into the left third tarsometatarsal joint, which provided transient relief. Chiropractic treatment included flexible custom orthotics prescribed to specifically address her foot pronation. This was the only chiropractic treatment employed. CONCLUSION: In the presented case, the sensitivity of MRI to stress-induced BME identified the cause of this patient's symptoms and, more importantly, directed management. Because of its ability to demonstrate anatomic and physiologic information, MRI is the ideal imaging modality for assessing suspected injury to the osseous tissues. In patients who relay historical information that suggests chronic or acute osseous injury but demonstrate no radiographic changes to support the clinical suspicion of bony abnormality, an MRI may be indicated to exclude occult injury.
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Enfermedades de la Médula Ósea/diagnóstico , Edema/diagnóstico , Traumatismos de los Pies/complicaciones , Imagen por Resonancia Magnética , Carrera/lesiones , Yoga , Adulto , Fenómenos Biomecánicos , Enfermedades de la Médula Ósea/etiología , Edema/etiología , Femenino , Humanos , Sensibilidad y EspecificidadRESUMEN
Hyperuricemia is a common manifestation in various hematological disorders such as hemolytic anemias, megaloblastic anemia malignant lymphomas and leukemias. Tumor lysis syndrome (TLS) is a serious complication consists of hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia due to massive cell lysis, which occurs shortly after the onset of chemotherapy or radiotherapy for acute leukemias and malignant lymphomas. Acute renal failure may develop due to uric acid nephropathy. The risk factors of TLS are heavy tumor cell burden, rapid cell turn over rate and renal involvement of neoplastic cells. To prevent and control TLS, adequate intravenous hydration to keep patient's urine volume, alkalization of urine by sodium bicarbonate and inhibition of uric acid production by high dose allopurinol is recommended.
Asunto(s)
Enfermedades Hematológicas/complicaciones , Síndrome de Lisis Tumoral/etiología , Ácido Úrico/sangre , Médula Ósea/patología , Enfermedades de la Médula Ósea/etiología , Humanos , Enfermedades Renales/etiología , NecrosisRESUMEN
We describe 9 patients with radiation myelopathy treated by hyperbaric oxygenation (HBO). In this retrospective study, six out of nine (66%) could have been stabilized or improved by HBO. Physiopathological mechanisms of radiation myelopathy remain controversial and incompletely known. We discuss the putative mechanisms of the beneficial action of HBO on radiation myelopathy. Controlled studies are required to clarify the interest of HBO in this disease.